Clinical Case for Residents (I) – 62-year-old man with primary Sjögren’s disease and progressive bone pain

Abstract

This document is part of the Clinical Cases for Residents collection, a teaching project aimed at postgraduate training in Rheumatology and also applicable to other medical specialties involved in the management of systemic diseases. Its purpose is to strengthen clinical reasoning skills, syndromic analysis, and the structured development of differential diagnoses in complex clinical scenarios.

The case presents a comprehensive evaluation of a patient with Sjögren’s disease and progressive bone pain, including a detailed discussion of the differential diagnoses and the reasoning that supports the likelihood of hypophosphatemic osteomalacia secondary to a possible acquired Fanconi syndrome. The document provides key elements for clinical interpretation, relevant complementary tests, and the underlying pathophysiological explanation.

The case is designed as a teaching tool for medical residents, with activities focused on group work, guided discussion, and the integration of clinical, analytical, and imaging findings. It forms part of a collection intended to reinforce advanced competencies in differential diagnosis, integrative clinical analysis, and evidence-based decision-making in real-world clinical practice.